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Adherence to swallowing recommendations during (chemo)radiotherapy in head and neck cancer survivors: a scoping review. Curr Opin Otolaryngol Head Neck Surg 2023; 31:171-179. [PMID: 36912234 DOI: 10.1097/moo.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW There is a paucity of knowledge regarding patient adherence to dysphagia recommendations. It is recognized that unique barriers and facilitators contribute to poor treatment adherence in head and neck cancer (HNC) survivors. This review aims to identify the key themes and knowledge gaps regarding adherence to swallowing recommendations in HNC survivors during (chemo)radiotherapy (C)RT. RECENT FINDINGS Seven studies were identified. Six facilitators to adherence were extracted, namely pain relief, behavioural intervention, attendance at multidisciplinary clinic, individualised swallowing therapy, absence of prophylactic percutaneous endoscopic gastronomy (PEG) and positive social control from a spouse. Barriers to adherence included pain, depression and presence of prophylactic PEG. Adherence to swallowing recommendations positively impacted swallowing outcomes in one study. SUMMARY Little is known about adherence to swallowing recommendations during (C)RT in HNC survivors. Capturing adherence is challenging. Several knowledge gaps were identified. Further research is needed to better understand the barriers and facilitators from the survivors' perspective. This will inform development of best practice regarding how swallowing recommendations are provided to promote adherence and improve outcomes.
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Kanatas A, Lowe D, Rogers SN. The Patient Concerns Inventory in head and neck oncology: a structured review of its development, validation and clinical implications. Eur Arch Otorhinolaryngol 2022; 279:5097-5111. [PMID: 35842858 PMCID: PMC9519723 DOI: 10.1007/s00405-022-07499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
Introduction The Patient Concerns Inventory (PCI) is a condition specific prompt list that was initially developed for head and neck cancer (HNC) and is referred to as the PCI–HN. There have been numerous publications regarding the PCI–HN, since it was first published in 2009. To date, there has not been a review of its development, validation and clinical implications. A collation of relevant papers into key sections allows multidisciplinary teams and researchers to have an overview of the PCI–HN’s background, evaluation and utility. This is essential if colleagues are to have confidence in the tool and be able to reflect on how to optimise its use in clinical practice. Methods Five search engines were used: EMBASE, Medline, PubMed, CINAHL and Handle-on-QOL for the specific term ‘Patient Concerns Inventory’ up to and including 1st February 2022. In addition, an accumulation of PCI–HN data of 507 HNC patients was drawn from previous studies in Liverpool and Leeds between 2007 and 2020 and was analysed specifically for this paper. Results 54 papers relating to the PCI–HN were identified. The review is structured into eight sections: (1) What is the PCI–HN and how does it work; (2) Feasibility and acceptability; (3) Psychometrics; (4) Items selected and frequency (5) Associations with Health-Related Quality of Life (HRQOL) and casemix; (6) Other observational studies; (7) Randomised trial evaluation; (8) General discussion and further research. Conclusions As the term PCI is quite ubiquitous and produces many hits when searching the literature, this review provides a very concise and convenient historical context for the PCI–HN and collates the current literature.
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Affiliation(s)
- Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | | | - Simon N. Rogers
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, L39 4QP UK
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
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Risk stratification for poor health-related quality of life following head and neck cancer through the aid of a one-page item prompt list. Int J Oral Maxillofac Surg 2021; 51:1000-1006. [PMID: 34686397 DOI: 10.1016/j.ijom.2021.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/29/2021] [Accepted: 08/05/2021] [Indexed: 01/09/2023]
Abstract
The aim of this work was to evaluate the usability of a single-page, patient-completed, condition-specific prompt list, the Patient Concerns Inventory (PCI-HN), to risk-stratify for poor health-related quality of life (HRQOL). Data were collected between 2008 and 2017. The main dataset comprised 310 patients first completing the PCI-HN and University of Washington Quality of Life questionnaire (UW-QOLv4) between 2012 and 2017. Another 201 patients first completing the PCI-HN between 2008 and 2011 provided a second dataset for independent validation. Subsequent completions of the PCI-HN in both groups and the distress thermometer (DT) were also used as further validation datasets. Associations between PCI-HN items selected by patients and a range of UW-QOLv4 outcomes were explored using conventional logistic regression and Chi-squared automated interaction detection (CHAID) analyses. One quarter of patients reported less than good HRQOL, range 26-29% across the four datasets. Several individual items from within the PCI-HN were predictive of adverse outcomes. The total number of items selected was also predictive. The single-sheet prompt list enables clinicians to identify patients at high risk of poor HRQOL. This simple approach has the potential to be integrated into routine clinical practice.
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Rogers SN, Allmark C, Bekiroglu F, Edwards RT, Fabbroni G, Flavel R, Highet V, Ho MWS, Humphris GM, Jones TM, Khattak O, Lancaster J, Loh C, Lowe D, Lowies C, Macareavy D, Moor J, Ong TK, Prasai A, Roland N, Semple C, Spencer LH, Tandon S, Thomas SJ, Schache A, Shaw RJ, Kanatas A. Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: main results of a cluster preference randomised controlled trial. Eur Arch Otorhinolaryngol 2021; 278:3435-3449. [PMID: 33346856 PMCID: PMC7751263 DOI: 10.1007/s00405-020-06533-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/27/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The patient concerns inventory (PCI) is a prompt list allowing head and neck cancer (HNC) patients to discuss issues that otherwise might be overlooked. This trial evaluated the effectiveness of using the PCI at routine outpatient clinics for one year after treatment on health-related QOL (HRQOL). METHODS A pragmatic cluster preference randomised control trial with 15 consultants, 8 'using' and 7 'not using' the PCI intervention. Patients treated with curative intent (all sites, disease stages, treatments) were eligible. RESULTS Consultants saw a median (inter-quartile range) 16 (13-26) patients, with 140 PCI and 148 control patients. Of the pre-specified outcomes, the 12-month results for the mean University of Washington Quality of Life (UW-QOLv4) social-emotional subscale score suggested a small clinical effect of intervention of 4.6 units (95% CI 0.2, 9.0), p = 0.04 after full adjustment for pre-stated case-mix. Results for UW-QOLv4 overall quality of life being less than good at 12 months (primary outcome) also favoured the PCI with a risk ratio of 0.83 (95% CI 0.66, 1.06) and absolute risk 4.8% (- 2.9%, 12.9%) but without achieving statistical significance. Other non-a-priori analyses, including all 12 UWQOL domains and at consultant level also suggested better HRQOL with PCI. Consultation times were unaffected and the number of items selected decreased over time. CONCLUSION This novel trial supports the integration of the PCI approach into routine consultations as a simple low-cost means of benefiting HNC patients. It adds to a growing body of evidence supporting the use of patient prompt lists more generally.
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Affiliation(s)
- Simon N. Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Liverpool, L39 4QP UK
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christine Allmark
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Fazilet Bekiroglu
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Rhiannon Tudor Edwards
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Gillon Fabbroni
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | | | - Victoria Highet
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Michael W. S. Ho
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Gerald M. Humphris
- School of Medicine, Medical & Biological Sciences, North Haugh, St Andrews, UK
| | - Terry M. Jones
- Liverpool Head and Neck Centre, University of Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9GA UK
| | - Owais Khattak
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Jeffrey Lancaster
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Christopher Loh
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | | | - Cher Lowies
- Liverpool Head and Neck Clinical Trials, Clinical Sciences Building, University Hospital Aintree, Liverpool, UK
| | - Dominic Macareavy
- Chair of the Head and Neck Patient and Carer Research Forum, Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - James Moor
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - T. K. Ong
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - A. Prasai
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
| | - Nicholas Roland
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Cherith Semple
- Institute of Nursing and Health Research, Ulster University, Shore Road, Belfast, Newtownabbey, Co, BT37 0QB Antrim, Belfast UK
- South Eastern Health and Social Care Upper Newtownards Road, Belfast, BT16 1RH UK
| | - Llinos Haf Spencer
- Centre for Health Economics and Medicines Evaluation (CHEME), School of Health Sciences, College of Human Sciences, Ardudwy Hall, Normal Site, Bangor University, Bangor, Wales UK
| | - Sank Tandon
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Steven J. Thomas
- Oral and Maxillofacial Surgery Department, Bristol University, Lower Maudlin Street, Bristol, UK
| | - Andrew Schache
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Richard J. Shaw
- Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK
| | - Anastasios Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK
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Bakshi SS, Kalidoss VK. Patient concern inventory: an effective tool for easing telemedicine during the COVID-19 pandemic. Wien Klin Wochenschr 2021; 133:989-990. [PMID: 33852072 PMCID: PMC8044500 DOI: 10.1007/s00508-021-01860-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Satvinder Singh Bakshi
- Department of ENT and Head & Neck Surgery, AIIMS Mangalagiri, 522503, Guntur, Andhra Pradesh, India.
| | - Vinoth Kumar Kalidoss
- Department of Community and Family Medicine, AIIMS Mangalagiri, 522503, Guntur, Andhra Pradesh, India
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Rogers SN, Semple CJ, Humphris GM, Lowe D, Kanatas A. Using the Patient Concerns Inventory in the identification of fatigue following treatment for head and neck cancer. Int J Oral Maxillofac Surg 2020; 50:865-872. [PMID: 33250271 DOI: 10.1016/j.ijom.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/10/2020] [Accepted: 11/02/2020] [Indexed: 11/27/2022]
Abstract
Fatigue has a profound impact on health-related quality of life (HRQOL). The aim of this study was to describe the clinical characteristics and HRQOL of head and neck cancer patients who raised the issue of fatigue on the Patient Concerns Inventory (PCI) at their review consultation. Eight consultants were randomized to use the PCI as part of a cluster-controlled trial. Patients also completed the University of Washington Quality of Life version 4 (UWQOL), EQ-5D-5L (EuroQol Group), and Distress Thermometer questionnaires. The study included 140 patients who attended clinics at a median of 108 (interquartile range 70-165) days after the end of treatment. The PCI item 'fatigue' was the sixth most commonly selected, by 29% (n=40). Those with advanced tumours were more likely to have selected the item (30/84, 36% vs 10/56, 18%; P=0.02), as were those treated with radiotherapy±chemotherapy (34/87, 39% vs 6/53, 11%; P<0.001). The PCI fatigue group reported significantly worse overall quality of life, social-emotional and physical function composite scores (UWQOL), Distress Thermometer, and EQ-5D-5L. PCI fatigue was common in those with sleeping, nausea, mood, depression, mobility, breathing, and energy level concerns. In conclusion, given the problems associated with fatigue, it is appropriate to screen and seek interventions that might help patients address this.
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Affiliation(s)
- S N Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK; Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK.
| | - C J Semple
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Co. Antrim, UK; South Eastern Health and Social Care, Upper Newtownards Road, Belfast, UK.
| | - G M Humphris
- School of Medicine, Medical and Biological Sciences, University of St Andrews, St Andrews, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - A Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, Leeds, UK.
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Changing paradigms in the treatment of residual/recurrent head and neck cancer: implications for dysphagia management. Curr Opin Otolaryngol Head Neck Surg 2020; 28:165-171. [DOI: 10.1097/moo.0000000000000620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Shunmugasundaram C, Rutherford C, Butow PN, Sundaresan P, Dhillon HM. Content comparison of unmet needs self-report measures used in patients with head and neck cancer: A systematic review. Psychooncology 2019; 28:2295-2306. [PMID: 31654540 DOI: 10.1002/pon.5257] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Morbidity from head and neck cancers (HNCs) and their treatment are significant, given their proximity to anatomical sites impacting facial appearance and function. Assessing the needs of HNC patients throughout their cancer journey is critical to informing quality care and improving quality of life. We aimed to identify available unmet needs measures in the HNC setting and appraise their content and psychometric properties. METHODS We conducted a systematic search of five electronic databases (July 2007-July 2019) to identify studies of unmet needs in patients with HNC. In addition, three web-based patient-reported outcome measures (PROMs) databases were searched for unmet needs measures. Citations were screened for eligibility and identified measures reviewed for content coverage and psychometric properties. From identified measures and literature, a conceptual framework with 12 clinically relevant aspects of unmet needs was developed and used to assess the conceptual coverage of available unmet needs measures. RESULTS Literature search identified 273 records of which 28 studies assessing unmet needs in HNC cancer met eligibility criteria. Seven unmet needs measures were identified from retrieved studies and seven additional measures from PROM databases. Thus, 14 measures in total were reviewed. Content mapping revealed that three measures demonstrated excellent content validity (greater than 80% conceptual coverage): Patient Concerns Inventory (PCI), Needs Assessment for Advanced Cancer Patients (NA-ACP), and James Supportive Care Screening (JSCS). CONCLUSION We recommend PCI be used to measure unmet needs in the HNC setting considering the importance of content validity over quantitative psychometric properties.
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Affiliation(s)
- Chindhu Shunmugasundaram
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Camperdown, New South Wales, Australia
| | - Phyllis N Butow
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology Network, Western Sydney Local Health District, North Parramatta, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Camperdown, New South Wales, Australia.,Psycho-Oncology Cooperative Research Group, University of Sydney, Camperdown, New South Wales, Australia
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Beck AJCC, Passchier E, Retèl VP, Stuiver MM, van der Molen L, Klop WMC, Navran A, van Harten WH, van den Brekel MWM. Study protocol of a prospective multicenter study comparing (cost-)effectiveness of a tailored interdisciplinary head and neck rehabilitation program to usual supportive care for patients treated with concomitant chemo- or bioradiotherapy. BMC Cancer 2019; 19:655. [PMID: 31269918 PMCID: PMC6610831 DOI: 10.1186/s12885-019-5874-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients. METHODS This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands. DISCUSSION This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised. TRIAL REGISTRATION The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).
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Affiliation(s)
- Ann-Jean C. C. Beck
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen Passchier
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Valesca P. Retèl
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
| | - Martijn M. Stuiver
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, the Netherlands
- ACHIEVE Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Willem M. C. Klop
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wim H. van Harten
- Division of Psychosocial Research and Epidemiology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Health Technology and Services Research, University of Twente, Enschede, the Netherlands
- Rijnstate Hospital, Arnhem, the Netherlands
| | - Michiel W. M. van den Brekel
- Department of Head and Neck Surgery and Oncology, the Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
- Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, the Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center (Amsterdam UMC), Amsterdam, the Netherlands
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Rogers SN, Thomson F, Lowe D. The Patient Concerns Inventory integrated as part of routine head and neck cancer follow-up consultations: frequency, case-mix, and items initiated by the patient. Ann R Coll Surg Engl 2018; 100:209-215. [PMID: 29364010 PMCID: PMC5930095 DOI: 10.1308/rcsann.2017.0215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing should be undertaken during oncology follow-up. We report the use of the Patient Concerns Inventory in a routine head and neck cancer clinic setting over a seven-year period, summarising the number of available clinics, the number of patients completing the inventory within a clinic, the range of clinical characteristics and the concerns they wanted to discuss. Methods The data were analysed from oncology follow-up clinics between 1 August 2007 and 10 December 2014. Audit approval was given by the Clinical Audit Department, University Hospital Aintree. Results There were 386 patients with 1198 inventories completed at 220 clinics, median 6 (range 4-7) per clinic. The most common concerns raised by patients across all the clinic consultations were dry mouth (34%), fear of recurrence (33%), sore mouth (26%), dental health (25%), chewing (22%) and fatigue/tiredness (21%). Conclusions The incorporation of the Patient Concerns Inventory as part of routine oncology clinics allows for a more patient initiated and focused consultation available to the majority of patients throughout their follow-up. The inventory allows for greater opportunity to provide holistic targeted multiprofessional intervention and support.
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Affiliation(s)
- SN Rogers
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - F Thomson
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
| | - D Lowe
- Evidence-Based Practice Research Centre, Faculty of Health and Social Care, Edge Hill University, Ormskirk, UK
- Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, UK
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The clinical nurse specialist's role in head and neck cancer care: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2017; 130:S212-S215. [PMID: 27841132 PMCID: PMC4873903 DOI: 10.1017/s0022215116000657] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the role of the clinical nurse specialist in the head and neck cancer patient journey and provides recommendations on the clinical nurse specialist led assessments and interventions for this group of patients receiving cancer care.
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Rogers SN, Lowe D, Kanatas A. Suitability of the Patient Concerns Inventory as a holistic screening tool in routine head and neck cancer follow-up clinics. Br J Oral Maxillofac Surg 2016; 54:415-21. [PMID: 26919767 DOI: 10.1016/j.bjoms.2016.01.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/14/2016] [Indexed: 11/25/2022]
Abstract
In patients with cancer of the head and neck, efficient screening for problems can improve care and the management of resources. We explored use of the Patient Concerns Inventory (PCI-HN) as a holistic screening tool in the follow up of these patients. Between August 2007 and January 2013, 464 patients completed the PCI-HN and the University of Washington Quality of Life questionnaire version 4 (UWQoL) immediately before their routine follow-up consultations. The median (IQR) number of items selected on the inventory was 3 (1-6). This was associated (p<0.001) with the number of serious problems (dysfunction) in the 12 UWQoL domains (Spearman's correlation, rs=0.51), overall QoL (rs=-0.41), and the 2 UWQoL subscale scores of physical (rs=-0.46) and social-emotional (rs=-0.53) function. Binary regression to predict an overall outcome of "less than good" indicated that use of the PCI could be better than just recording clinical characteristics. Some patients however, chose few PCI items and had numerous problems. The inventory may have a role in the screening of patients with cancer of the head and neck, particularly in relation to social-emotional function and overall QoL, and may have added value when used with the UWQoL-v4. The total number of PCI items selected is a useful predictor of QoL. Further research is required to confirm suitable limits, and to find out whether additional support and repeated use of the inventory over time improve QoL.
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Affiliation(s)
- S N Rogers
- Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, L39 4QP; Consultant Regional Maxillofacial Unit, University Hospital Aintree, Liverpool, L9 1AE, UK.
| | - D Lowe
- Faculty of Health and Social Care, Edge Hill University, St Helens Road, Ormskirk, L39 4QP.
| | - A Kanatas
- Oral and Maxillofacial Unit, Leeds Teaching Hospitals and St James Institute of Oncology, Leeds General Infirmary, LS1 3EX.
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Kanatas A, Humphris G, Lowe D, Rogers S. Further analysis of the emotional consequences of head and neck cancer as reflected by the Patients’ Concerns Inventory. Br J Oral Maxillofac Surg 2015; 53:711-8. [DOI: 10.1016/j.bjoms.2015.02.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/02/2015] [Indexed: 10/23/2022]
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Kanatas A, Singh P, Lowe D, Rogers SN. How will I be after my operation for oral cancer? Br J Oral Maxillofac Surg 2015; 53:538-45. [PMID: 25936243 DOI: 10.1016/j.bjoms.2014.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 10/04/2014] [Indexed: 10/23/2022]
Abstract
Validated health-related quality of life measures for patients with oral cancer have been available for over a decade. We used the Liverpool head and neck cancer database to identify 1060 patients who had curative operations for primary squamous cell carcinoma of the head and neck at the regional maxillofacial unit between 1995 and 2010. We then produced one-page summary tables for subsites of oral cancer by stage and common treatments based on patient-reported outcomes from the University of Washington quality of life (UWQoL) head and neck cancer questionnaire. Data had been collected in a series of annual surveys. Sites included were buccal and retromolar (n=189), oral tongue (n=358), floor of the mouth (n=321), and other oral sites (n=192). A total of 633 patients completed at least one questionnaire (total 1931) between 9 and 60 months after treatment (71% of those alive at 9 months). Only questionnaires completed around 2 years from diagnosis or operation were analysed. Data include crude survival at 1, 2, and 5 years, the 12 UWQoL domains, which comprise the number of patients who chose the best 2 responses for each, overall health-related QoL, and the number who chose the worst responses (based on an algorithm). The data are sufficiently detailed to be used in discussions with patients about likely outcomes. They can help patients to make decisions about the type of treatment, provide a reference for realistic expectations, and enable them to be better informed when they give their consent.
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Affiliation(s)
- A Kanatas
- Leeds Teaching Hospitals and St James Institute of Oncology, United Kingdom.
| | - P Singh
- School of Medicine, University of Liverpool, Liverpool L69 3GE, United Kingdom.
| | - D Lowe
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, Ormskirk L39 4QP, United Kingdom.
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health, Edge Hill University, Ormskirk L39 4QP, United Kingdom; Regional Maxillofacial Unit, University Hospital Aintree, Liverpool L9 1AE, United Kingdom.
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Rogers S, Audisio R, Lowe D. Do the elderly raise different issues when using the Patient Concerns Inventory in routine head and neck cancer follow-up clinics? Eur J Cancer Care (Engl) 2015; 24:189-97. [DOI: 10.1111/ecc.12289] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- S.N. Rogers
- Evidence-Based Practice Research Centre (EPRC); Faculty of Health and Social Care; Edge Hill University; Ormskirk UK
- Regional Maxillofacial Unit; University Hospital Aintree; Liverpool UK
| | - R.A. Audisio
- St Helens Teaching Hospital; University of Liverpool; St Helens UK
| | - D. Lowe
- Evidence-Based Practice Research Centre (EPRC); Faculty of Health and Social Care; Edge Hill University; Ormskirk UK
- Regional Maxillofacial Unit; University Hospital Aintree; Liverpool UK
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Rogers SN, Lowe D. An evaluation of the Head and Neck Cancer Patient Concerns Inventory across the Merseyside and Cheshire Network. Br J Oral Maxillofac Surg 2014; 52:615-23. [DOI: 10.1016/j.bjoms.2014.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Scott B, Ghazali N, Lowe D, Bekiroglu F, Rogers SN. The Patients Concerns Inventory in head and neck cancer: Comparison between self-completed paper and touch screen versions in the clinic setting. Eur J Oncol Nurs 2013; 17:863-9. [DOI: 10.1016/j.ejon.2013.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 04/19/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
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